Renewal Application
Required Clinical Laboratory Application Fees:
Laboratory application fees are dependent upon the type of laboartory and the volume of tests preformed
Background Screening:
Level 2 Background Screening must be completed for the laboratory director and the chief financial officer prior to approving the initial application and then repeated every five years. Please go to the background screening section of this web site for additional documentation that must be submitted with your application. Fingerprint cards are available by contacting the Laboratory Unit at 850-487-3109. Other fingerprint cards may not be acceptable.
Annual Affidavit of Background Screening Compliance
Each non - waived laboratory is required by section 435.04(05), Florida Statutes(2006) to submit an affidavit of compliance with this section. A recommended form is available at this the link below.
| NOTE: If after reviewing the application forms and statutory and rule requirements on our website you have additional questions, please call (850) 487-3109. Staff will be happy to answer questions that clarify the requirements as they apply to your specific situation, but cannot walk you through the application. Filling out the application is part of your responsibility as an applicant. The Agency's role in this process is to evaluate your application and, if there are elements missing from your application once submitted, provide you with an omissions response that gives you another opportunity to complete the application successfully. If you need extensive assistance in filling out your application, we would advise you to retain an attorney or a government relations consultant to assist you. |
Note: All applicants must complete the application information in items 1 through 4. Directors and Financial Officers of nonwaived laboratories must complete item 5 if background screening has been completed within the last five years.
- Renewal Application
- Health Care Licensing Application
- Health Care Licensing Application Addendum
- Voluntary Board Member Affidavit
- Affidavit of Compliance with Background Screening Requirements
|
